The Clinical Strategies Implementation Scale to Measure Implementation of Treatment in Mental Health Services

Department of Psychiatry, Keio University, Edo, Tōkyō, Japan
Psychiatric Services (Impact Factor: 2.41). 01/2006; 56(12):1584-90. DOI: 10.1176/
Source: PubMed


The authors describe the development of the Clinical Strategies Implementation Scale (CSI), an instrument designed to help providers measure the extent to which evidence-based strategies have been implemented in the treatment of persons with schizophrenia spectrum disorders.
Nine ordinal scales were devised to measure key aspects of treatment strategies that have been associated with clinical and social recovery from schizophrenia: goal- and problem-oriented assessment, medication strategies, assertive case management, mental health education, caregiver-based problem solving, living skills training, psychological strategies for residual problems, crisis prevention and intervention, and booster sessions. A study of interrater reliability was conducted with 15 trained raters from participating centers in Athens, Auckland, Bonn, Budapest, Gothenburg, and Tokyo who assessed 54 cases. Each treatment strategy was weighted according to its effect size in clinical trials. Correlation analyses were conducted to explore associations between the total CSI score and ratings of clinical, social, and caregiver outcomes each year over four years of continued treatment of 51 patients.
Interrater reliability ranged from .93 to .99. Four annual total CSI ratings were significantly correlated with impairment, disability, functioning, work activity, and an index of recovery. Most correlations were stronger in years 3 and 4 than in years 1 and 2.
Reliable and valid assessment of the implementation of evidence-based strategies in clinical practice is feasible. The quality of integrated program implementation may be associated with improved clinical and social recovery from schizophrenic disorders.

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    • "The Global Assessment of Functioning (GAF) is one instrument originally developed for this purpose (Endicott et al. 1976; Greenberg and Rosenheck 2005; Hall 1995; Moos et al. 2002). The Cornell Service Index is a measure of health services usage among clients of outpatient mental health services (Sirey et al. 2005), while the Clinical Strategies Implementation Scale is frequently used to assess whether evidence-based practices are used in mental health services for persons with schizophrenia (Falloon et al. 2005; Resnick 2005). The Level of Care Utilization System (LOCUS) (Sowers et al. 1999) was developed to provide a way to assess services needs of adults and to quantify services based on the amount and scope of resources available to clients at each level of service. "
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    ABSTRACT: The concept of recovery can be operationalized from either the point of view of the consumer, or from the perspective of the agency providing services. The Milestones of Recovery Scale (MORS) was created to capture aspects of recovery from the agency perspective. Evidence establishing the psychometric properties of the MORS was obtained in three efforts: Inter-rater reliability using staff at The Village, a multi-service organization serving the homeless mentally ill in Long Beach, California; inter-rater reliability was also obtained from Vinfen Corporation, a large provider of housing services to mentally ill persons in Boston, Massachusetts. A test-retest reliability study was conducted using staff rating of clients at The Village, and evidence for validity was obtained using the Level of Care Utilization System (LOCUS) as a validity measure. The intra-class correlation coefficient for the inter-rater reliability study was r = .85 (CI .81, .89) for The Village and r = .86 (CI .80, .90) for Vinfen Corporation; test-retest reliability was r = .85 (CI .81, .87); and validity coefficients for the LOCUS were at or above r = .49 for all subscales except one. There is sufficient evidence for the reliability and validity of the MORS.
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